Abstract
BackgroundPerioperative allogenic transfusion is required in almost 50% of patients undergoing cardiac surgery and is associated with higher risk of mortality and morbidity (Xue et al., Lancet 387:1905, 2016; Ferraris et al., Ann Thorac Surg 91:944–82, 2011). Acute normovolemic hemodilution (ANH) is recommended as a potential strategy during cardiac surgery, but the blood conservation effect and the degree of ANH was still controversial. There is also an increasing concern about the improved outcomes associated with ANH. Therefore, a better understanding of the effect of mild volume ANH during cardiac surgery is urgently needed.MethodsThis retrospective study included 2058 patients who underwent cardiac surgery between 2010 and 2015. The study population was split into two groups (with and without mild volume ANH). Propensity score adjustment analysis was applied. We reported the association between the use of mild volume ANH and perioperative outcomes.ResultsA total of 1289 patients were identified. ANH was performed in 358 patients, and the remaining 931 patients did not receive any ANH. Five hundred of the total patients (38.8%) received perioperative RBC transfusions, 10% (129/1289) of patients received platelet, and 56.4% (727/1289) of patients received fresh frozen plasma transfusions. Mild volume ANH administration was significantly associated with decreased intraoperative RBC transfuse rate (8.5% vs. 14.4%; p = 0.013), number of RBC units (p = 0.019), and decreased postoperative pulmonary infection (6.8 vs. 11.3%; p = 0.036) during cardiac surgery. However, there was no significant difference regarding intraoperative fresh frozen plasma (FFP) and platelet concentrate transfusions, as well as postoperative and total perioperative allogeneic transfusions. Furthermore, there was no significant difference regarding postoperative outcomes including mortality, prolonged wound healing, stroke, atrial fibrillation, reoperation for postoperative bleeding and acute kidney injury. There was also no difference in postoperative ventilation time, length of ICU and hospital stay.ConclusionBased on the 5-year experience of mild volume ANH in cardiac surgeries with CPB in our large retrospective cohort, mild volume ANH was associated with decreased intraoperative RBC transfusion and postoperative pulmonary infection in Chinese patients undergoing cardiac surgery. However, there was no significant difference regarding postoperative and total perioperative allogeneic transfusions.
Highlights
Perioperative allogenic transfusion is required in almost 50% of patients undergoing cardiac surgery and is associated with higher risk of mortality and morbidity (Xue et al, Lancet 387:1905, 2016; Ferraris et al, Ann Thorac Surg 91:944–82, 2011)
In our retrospective analysis of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), we found that mild volume Acute normovolemic hemodilution (ANH) was associated with decreased intraoperative Red blood cells (RBC) transfusions rate and number of RBC units after data adjustment for preoperative risk factors
We did not observe the positive effect of ANH regarding mortality, stroke, atrial fibrillation (AF), acute kidney injury (AKI), and resternotomy for postoperative bleeding, our findings suggest that mild volume ANH might be associated with lower incidence of pulmonary infection
Summary
Perioperative allogenic transfusion is required in almost 50% of patients undergoing cardiac surgery and is associated with higher risk of mortality and morbidity (Xue et al, Lancet 387:1905, 2016; Ferraris et al, Ann Thorac Surg 91:944–82, 2011). Perioperative allogenic transfusion is required in about 50% of patients undergoing cardiac surgery [2], but it is associated with higher risk of mortality and morbidity (infection, lung injury, renal failure, and stroke) [3,4,5]. Many trials have confirmed the positive effects of ANH in reducing perioperative allogeneic transfusions [6, 7]; other studies have reported negative effects [8, 9]. Another important debated point is the degree of ANH performed. There may be a risk of performing moderate or severe ANH in patients with a lower preoperative hematocrit level in cardiac surgery with cardiopulmonary bypass (CPB) which would lead to hemodilution [12]
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